Workers’ Comp’s Mixed Bag of Prescription Costs and Utilization Trends for 2023: Report

Workers’ compensation prescription costs and utilization saw notable changes in 2023, with an overall decrease in per claim costs and continued declines in opioid prescribing, according to an analysis by Enlyte.

Despite these promising trends, certain therapeutic classes experienced double-digit cost increases as the industry grappled with addressing new prescribing patterns. In 2023, utilization per claim decreased by 5.2% and cost per claim edged down 0.2%.

These are some of the findings of Part 1 of a four-part series titled, “2024 Pharmacy Solutions Drug Trends Report” by Enlyte. This first installment focuses on retail and mail-order transactions billed through Enlyte’s combined pharmacy benefit management programs.

However, cost per script rose 5.2% across the classes, per the report. In fact, eight of the top 10 therapeutic classes experienced an increase in cost per script, with two classes jumping by double-digits. Respiratory medications had the largest rise at 14.7%, followed by migraine drugs at 10.2%. These substantial increases in cost per script align with the fact that respiratory and migraine medications were among the top five classes with brand average wholesale price (AWP) increases this past year.

Utilization told a somewhat different story, declining for every therapeutic class except one: migraine medications surged 17% in utilization per claim, the report found. All other top classes saw utilization drop in 2023, even as their cost per script climbed.

Opioid Prescribing Trends

Opioid prescribing showed notable decreases in 2023 across all categories. Utilization of sustained-release opioids dropped by over 10% compared to the previous year. Overall, opioid utilization per workers’ compensation claim decreased 9.7% and cost per claim fell by 7.2%.

Prescribing guidelines have played an important role in supporting these downward trends in opioid utilization. By providing standards and best practices for when and how to prescribe opioids appropriately, these guidelines have helped reduce unnecessary prescribing.

“We have, as an industry, seen this trend continue where prescribers are becoming more educated about the opioid epidemic, the dangers of opioids, educating patients,” said Nikki Wilson, Senior Director of Clinical Pharmacy Services for Enlyte. “Our industry certainly does a very good job of assisting with controls and utilization. State regulations are catching up in terms of limiting those dispensing quantities. So a number of reasons that we’re seeing things go down.”

Utilization per claim also trended down in 2023 for opioid alternatives frequently prescribed to treat acute and chronic pain, such as NSAIDs and muscle relaxants, according to the report. However, the decreases in this category were smaller than the drops seen for opioids, indicating that prescribers may be shifting toward these alternatives where appropriate. As prescribing patterns continue to evolve, monitoring utilization of both opioids and common alternatives will provide insight into how pain management strategies are changing in workers’ compensation.

Specialty Medications and Claim Stage Considerations

The rising cost of specialty medications continues to be a major trend impacting workers’ compensation pharmacy spend. Specialty spend as a percentage of overall prescription spend has nearly tripled over the past six years, jumping from 5.9% in 2018 to 15.3% in 2023. The AWP for these high-cost specialty medications increased by 3.3% in 2023, reaching an average of $1,906 per script.

In addition to the impact of specialty drugs, there are notable differences in medication usage based on the stage of a workers’ comp claim. For claims less than two years old, non-opioid analgesics (including NSAIDs and topicals), muscle relaxants, and anti-infective agents were more commonly prescribed to treat injuries.

However, claims that extended beyond the two year mark saw higher utilization of anticonvulsants, antidepressants, and sustained-release opioids. Cardiovascular, respiratory, and gastrointestinal medications were also used more frequently in claims older than two years.

To access the full Part 1 installment, visit Enlyte’s website. &